Nubbed Plate

ABSTRACT

A separate nub component between the plate and an intervertebral fusion cage, wherein the nub is attached to the plate. The nub lessens the undesired pivotal movement of the plate. It is believed that when the nub fits snugly between the endplates of the adjacent vertebral bodies, it acts as a stop against the undesired pivotal movement of the plate.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No.16/414,064 filed May 16, 2019, which is a continuation of U.S. patentapplication Ser. No. 15/846,344 filed Dec. 19, 2017, which is acontinuation application of U.S. Patent application Ser. No. 15/581,571filed Apr. 28, 2017, which is a continuation application of U.S. patentapplication Ser. No. 14/845,481, filed Sep. 4, 2015, which is acontinuation of U.S. patent application Ser. No. 13/413,264 filed Mar.6, 2012, the disclosures of each of which are hereby incorporated byreference as if set forth in their entirety herein.

BACKGROUND OF THE INVENTION

A lateral access approach is frequently selected to deliverintervertebral fusion cages to the lumbar spine. Compared toconventional anterior or posterior approaches to the lumbar spine, thelateral approach is thought to minimize posterior and/or anterior tissuedamage as well as reduce surgery time, associated blood loss, vasculardamage and infection risk.

In general, it is known in the art to mount a laterally-placed fusioncage with a plate that secures to the sides of adjacent vertebralbodies. This plate attaches to a side of each vertebral body adjacentthe operative disc space. The primary purpose of the plate is to reducethe patient's ability to undergo excessive extension, therebyeliminating the need for the surgeon to implant posterior fixation.

U.S. Pat. No. 7,594,931 (Louis) discloses an intervertebral arthrodesisimplant for insertion in an intervertebral space separating oppositefaces of two adjacent vertebrae. The implant has a ring-shapedintervertebral cage having a bar that extends perpendicular to the axisof the spine. The bar has a height less than the rest of the cage. Asurface of the cage contacting the vertebrae has an undulating shape forlimiting sliding of the cage in a plane parallel to the vertebral faces.

PCT Published Patent Application WO2011-080535 (Dinville) disclosesanchoring devices, anchoring systems for intervertebral implants,intervertebral implants, and instruments and methods for implanting theimplants. In preferred configurations, these various objects share thefeature of comprising or cooperating with an anchoring device having abody comprising at least one curved plate elongated along a longitudinalaxis. The plate is designed to be inserted through a passage crossing atleast a part of the implant in order to penetrate into at least onevertebral endplate and attach this implant onto this vertebral endplateby means of at least one stop retaining the implant. The body of theanchoring device comprises at least one longitudinal rib on at least apart of at least one of its faces, the rib being designed to cooperatewith a groove made in a passage of implant.

In one type of intervertebral device suited for the lateral approach,the fusion cage is mounted with a plate that secures the cage to theadjacent vertebral bodies. In particular, US Published PatentApplication 2010-0004747 (Lin) discloses a spinal fixation devicecomprising a trans-vertebral and intra-vertebral plate and a rectangularcage with a slot for the plate for neutralizing intervertebral movementin spinal interbody fusion. The rectangular cage with a vertical oroblique slot is inserted into the intervertebral space from the lateralor anterior side of the spinal column. The plate is then insertedthrough the slot of the cage and hammered into and buried inside the twoadjacent vertebral bodies to achieve three-dimensional intervertebralfixation.

U.S. Pat. No. 6,432,106 (Fraser I) discloses a spinal fixation assemblyincludes a fusion cage to which a plate is mated. The plate isconfigured to receive, retain and orient bone screws.

U.S. Pat. No. 7,112,222 (Fraser II) discloses one type of prior artdevice that combines a cage with a plate, so that the cage is integrallybound to the plate. A representative side view of this assembly is shownin FIG. 14.

U.S. Pat. No. 7,112,222 (Fraser II) further discloses a spinal fixationassembly is provided including a fusion cage with posterior, anterior,superior, and inferior faces, and a plate having at least one aperturefor receiving a bone screw and having a mating element adapted toslidably engage and mate to the anterior face of the fusion cage. Thecage is adapted to be positioned between adjacent vertebrae, and theplate is effective to mate to the cage and to receive one or more bonescrews to fasten the plate and secure the fusion cage to the adjacentvertebrae.

US Published Patent Application US 2011-0184415 discloses (Anderson)discloses a bone stabilization system is provided having a plate with atop and bottom surface and a hole therethrough extending along alongitudinal axis. An annular groove in the top surface encircles theaxis and defines outer facing sides of a plurality of spring membersintegral to the plate. A plurality of slots define sides of the springmembers the inward facing side of the spring members form the upperportion of the hole, which includes a first spherical portion. Afastener with a spherical portion on the fastener head extends into thehole with the spring members urged apart to allow the head to pass butrestraining removal until the resistance provide by the spring membersis overcome.

US Published Patent Application US 2007-0049941 discloses (Thramann)discloses a spinal fusion plate includes a means to support an adjacentvertebral segment to inhibit the adjacent vertebral segment from furtherdegeneration. The means to support includes an attachment to anassociated artificial disc or nucleus replacement, an extension, or anattachment to a bone anchor. In each case, the attachment is moveable inrelation to the fusion plate to allow flexion and extension.

U.S. Pat. No. 7,887,595 (Pimenta) discloses a spinal fusion implant ofnon-bone construction to be introduced into an intervertebral disc spacefor the promotion of spinal fusion.

SUMMARY OF THE INVENTION

It has been observed by the present inventors that simply attaching aplate component against the trailing end of a lateral cage onlyimperfectly arrests the extension-like movement of the patient's spine.Rather, it was noticed that there was some anterior-posterior pivotingof the plate about the screw that connected the plate to the cage. SeeFIG. 18.

Therefore, it is an object of the present invention to provide acage-plate assembly having a reduced ability to pivot.

In accordance with the present invention, the present inventors foundthat adding a separate nub component between the plate and cage, whereinthe nub is attached to the plate, lessens the undesired pivotal movementof the plate. It is believed that when the nub fits snugly between theendplates of the adjacent vertebral bodies, it acts as a stop againstthe undesired pivotal movement of the plate.

Therefore, in accordance with the present invention, there is providedan intervertebral fusion device comprising:

a) an intervertebral fusion cage having an anterior wall, a posteriorwall, leading and trailing walls connecting the anterior and posteriorwalls to form a central vertical throughhole, an upper surface adaptedfor gripping an upper endplate and a lower surface adapted for grippinga lower endplate;

b) a bone plate comprising upper and lower holes, c) a separate nubcomponent interposed between the bone plate and the trailing wall of thecage.

DESCRIPTION OF THE FIGURES

FIG. 1 shows a side view of a device of the present invention attachedto sidewalls of adjacent vertebral bodies.

FIG. 2 shows a front view of a device of the present invention attachedto sidewalls of adjacent vertebral bodies.

FIG. 3 shows a front view of a device of the present invention.

FIG. 4 shows a perspective view of a device of the present invention.

FIG. 5 shows a side view of a device of the present invention.

FIG. 6 shows a perspective view of a device of the present inventionwithout its cage.

FIG. 7 discloses a perspective view of a first embodiment of a polyaxialassembly of the present invention.

FIG. 8 discloses a perspective view of the plate and nub components ofthe first embodiment of a polyaxial assembly of the present invention.

FIG. 9 shows a side view of the first embodiment of a polyaxial assemblyof the present invention.

FIG. 10 shows a top view of the first embodiment of a polyaxial assemblyof the present invention.

FIG. 11 discloses a cross-section view of a second embodiment of apolyaxial assembly of the present invention.

FIG. 12 shows a top view of a concave bone plate attached to a sidewallof a vertebral body.

FIG. 13 shows a side view of a concave bone plate attached to bothsidewalls of adjacent vertebral bodies.

FIG. 14 discloses a side view of a conventional fusion device comprisingan integral cage and plate.

FIG. 15 is a side view of a device of the present invention in which thenub and plate are integral.

FIG. 16 discloses a threaded post of the present invention.

FIG. 17 discloses a post of the present invention having a sphericalhead.

FIG. 18 discloses a side view of a conventional cage-plate assemblyinserted in a disc space.

DETAILED DESCRIPTION OF THE INVENTION

Now referring to FIGS. 1-6, there is provided an intervertebral fusiondevice comprising:

a) an intervertebral fusion cage 1 having an anterior wall 3, aposterior wall 5, a leading wall 7 and a trailing wall 9 connecting theanterior and posterior walls to form a central vertical throughhole 11,an upper surface 13 adapted for gripping an upper endplate and a lowersurface 15 adapted for gripping a lower endplate;

b) a bone plate 21 comprising an upper hole 23, a lower hole 25, and acentral hole 27 disposed substantially between the first and secondholes,

-   -   c) a nub 31 interposed between the bone plate and the trailing        wall of the cage, the nub comprising:    -   i) a first wall 33 contacting the trailing wall of the cage,    -   ii) a second wall 35 contacting the bone plate,    -   iii) a threaded throughhole 37 extending from the first wall to        the second wall, and

d) a threaded post 41 received in the throughhole of the nub and passingthrough the central hole of the bone plate.

In some embodiments, the assembly has a polyaxial joint. It is believedthat the inclusion of this polyaxial joint is very advantageous to theperformance of the device. It has been noticed that typical variationsin human physiology often result in a situation in which the sidewallsof the adjacent vertebrae that hold the plate are not coplanar with eachother. Rather, one sidewall often extends out farther than its adjacentsidewall. Thus, when a conventional cage-plate assembly (in which theplate is rigidly attached to the cage in a perpendicular relationship)is used on a typical functional spinal unit, the lack of a coplanarrelationship in the vertebral sidewalls leads to a fixation situation inwhich only one of the vertebral sidewalls will actually contact theplate. This asymmetrical contact undesirably leads to stressconcentration and poor distribution of biomechanical forces (as onescrew is loaded more), leading to bony fracture.

It is believed that a polyaxial joint in the cage-plate assemblyalleviates these concerns. When the cage-plate assembly of the presentinvention is used on a typical functional spinal unit lacking coplanarvertebral sidewalls, the plate can be polyaxially adjusted about thecage until it contacts each of the sidewalls and then locked at thatdesired angle. This produces a fixation in which asymmetrical contact iseliminated.

Therefore, in accordance with the present invention, there is providedan intervertebral fusion device comprising:

a) an intervertebral fusion cage having an anterior wall, a posteriorwall, leading and trailing walls connecting the anterior and posteriorwalls to form a central vertical throughhole, an upper surface adaptedfor gripping an upper endplate and a lower surface adapted for grippinga lower endplate, the upper and lower surface defining a cage height;

b) a bone plate comprising a bone contacting surface, and outer surface,upper and lower holes passing from the bone-contacting surface to theouter surface, and a projection extending distally from the bonecontacting surface and having a height,

wherein the bone plate is connected to the trailing wall of the cage viaa polyaxial connection.

Also in accordance with the present invention, there is provided anassembly device for fusing a disc space, comprising:

a) a bone plate comprising a bone-contacting inner surface, an outersurface, upper and lower holes, a central hole, each hole passing fromthe outer surface to the inner surface,

b) an intervertebral component comprising:

-   -   i) a first wall facing the disc space,    -   ii) a second wall contacting the inner surface of the bone        plate,

c) first and second bone anchors passing through the upper and lowerholes of the bone plate, wherein the bone plate forms a polyaxial jointwith the intervertebral component.

In a first polyaxial embodiment, and now referring to FIGS. 7, 8 and 10,the proximal head of the post comprises a spherical surface 43. Thisspherical surface can form a polyaxial joint with a mating sphericalsurface 45 formed in the central hole of the plate. Again, the polyaxialconnection is advantageous for adjusting the orientation of the plate sothat it evenly contacts both sidewalls of the adjacent vertebral bodies.Once the proper angulation is found, the post may be further threadablytightened into the nub to lock the desired angle.

Therefore, in accordance with the present invention, there is providedan interbody device for fusing a disc space, comprising:

a) a bone plate comprising a bone contacting inner surface, an outersurface, upper and lower holes, a central hole having a sphericalsurface thereon, each hole passing from the outer surface to the innersurface,

b) an intervertebral component comprising:

-   -   i) a first wall facing the disc space,    -   ii) a second wall contacting the inner surface of the bone        plate,    -   iii) a threaded throughhole extending from the first wall to the        second wall,

c) first and second bone anchors passing through the upper and lowerholes of the bone plate,

d) a post having a proximal spherical head and a distal threaded shaft,

wherein the inner surface of the bone plate contacts the second wall ofthe intervertebral component,

wherein the central hole of the bone plate and the threaded throughholeof the intervertebral component align,

wherein the distal threaded shaft of the post is threadably received inthe threaded throughhole of the nub, and wherein the proximal sphericalhead of the post is received in the spherical surface of the centralhole of the bone plate to form a polyaxial joint).

Now referring to FIGS. 7-10, in some embodiments in which the plate andpost form a polyaxial joint, the second wall of the nub (which contactsthe bone plate) has a convex surface 47. This convex surface is usefulin the polyaxial joint embodiments of the present invention because itaccommodates more tilting of the plate with respect to the nub whilemaintaining the joint.

Likewise, in some embodiments in which the plate and post form apolyaxial joint, the inner surface of the bone plate has a concavesurface 49. This concave surface is useful in the polyaxial jointembodiments in which the second wall of the nub is convex because itaccommodates more tilting of the plate with respect to the nub whilemaintaining the joint.

In some embodiments, and now referring to FIG. 9, the shaft 95 of theupper bone anchor 91 and the upper surface 13 of the cage define a firstangle α, the shaft 96 of the lower bone anchor 92 and the lower surface15 of the cage define a second angle β, and the first angle a is notequal to second angle β. This condition occurs when a polyaxial joint iscreated between the nub and bone plate, and the adjacent vertebralbodies do not align in a co-planar manner. In some embodiments thereof,the first angle a differs from second angle β by at least 5 degrees.

In a second polyaxial preferred embodiment, and now referring to FIG.11, the plate has an annular projection 51 extending distally from itsinner surface 52 about the central hole, and the nub has a recessedsurface 53 extending distally about its throughhole 54 from its secondwall, so that the annular projection forms a polyaxial joint 55 with therecessed surface of the nub. The polyaxial nature of the connectionbetween the plate and nub allows the plate to float over the nub. Thisability to float facilitates the plate's fit upon vertebral bodysidewall surfaces that are often not aligned in a coplanar manner. Apost may be added to the assembly by passing it through the plate'scentral hole and attaching to the nub's throughhole. Now referring toFIG. 16, a thread 57 on the post's shaft 58 allows it to threadably matewith the throughhole of the nub, while a head 59 on the proximal endportion 61 of the post allows it to loosely retain the plate upon thenub. Thus the post acts to retain the plate on the nub while allowingthe polyaxial connection to retain its ability to move. Once the desiredangulation is achieved, the post may be further tightened upon theassembly to lock the desired angulation.

It is believed that the device of FIG. 11 represents the first polyaxialplate known to the present inventors.

Therefore, in accordance with the present invention, there is providedan interbody device for fusing a disc space, comprising:

a) a bone plate comprising a bone contacting inner surface, an outersurface, upper and lower holes, a central hole, each hole passing fromthe outer surface to the inner surface, and an annular projectionextending distally from the inner surface about the central hole,

b) an intervertebral component comprising:

-   -   i) a first wall facing the disc space,    -   ii) a second wall contacting the inner surface of the bone        plate,    -   iii) a throughhole extending from the first wall to the second        wall, iv) a recessed surface extending distally about the        throughhole,

c) first and second bone anchors passing through the upper and lowerholes of the bone plate,

wherein the annular projection of the bone plate forms a polyaxial jointwith the recessed surface of the intervertebral component.

In general, the cage of the present invention can be any interbodyfusion cage suitable for promoting fusion between two vertebral bodies.The cage can be adapted for lumbar, cervical or thoracic use. The cagecan be adapted for lateral, posterior, or anterior insertion. In somepreferred embodiments, the cage is adapted for lateral approach to thelumbar spine. Typically, the cage will have an anterior wall, aposterior wall, leading and trailing walls connecting the anterior andposterior walls to form a central vertical throughhole, an upper surfaceadapted for gripping an upper endplate and a lower surface adapted forgripping a lower endplate. The central vertical throughhole facilitatesbone growth between the two adjacent vertebral endplates. Each of theposterior and anterior walls may have ventral-dorsal throughholes 62therethrough in order to accommodate fusion as well. The leading wall ofthe lateral cage may have a bulleted nose 63 that eases insertion intothe disc space.

The bone plate of the present invention typically comprises abone-contacting inner surface, an outer surface, and upper and lowerholes passing from the bone-contacting surface to the outer surface.Bone anchors pass through these upper and lower holes to thereby anchorthe plate to the adjacent vertebral bodies.

In some embodiments, and now referring to FIGS. 7, 8, and 10, thecentral hole of the plate (into which the post seats) opens laterallyonto a sidewall 65 of the plate. The purpose of this lateral opening isto allow a snap-fit assembly. It is believed that when this openingconstitutes about 40% of the central hole periphery, the snap fit willbe sufficiently robust so as to hold plate on the post.

In some embodiments, the central hole in the plate is provided in theform of an elongated slot. The elongated slot allows for slidableadjustment of the plate upon the nub, thereby allowing for a fine tuningof the plate location after the nub location is set.

In some embodiments, the bone-contacting inner surface of the platenarrows distally. This contouring helps the plate fit between theadjacent vertebrae. This feature is believed to be advantageous in MISprocedures in which the components are inserted into the spinal areathrough a tube in the absence of a clear line of sight on the part ofthe surgeon.

In some embodiments, as in FIG. 13, the outer surface 67 of the boneplate is convex. This condition helps the plate conform to the convexbony surfaces of the adjacent vertebrae.

In some embodiments, as in FIG. 12, the bone-contacting inner surface 69of the bone plate is concave. This condition helps the plate conform tothe convex bony surfaces of the adjacent vertebrae.

In some embodiments, as in FIG. 3, the inner surface of the platefurther comprises a radius 201 and a projection 203. This radiusadvantageously matches the contour of the vertebral body in this region.

As discussed above, the purpose of the nub is to prevent undesiredpivoting of the plate about its centerpoint.

In some embodiments, the cage, plate and nub are present as separatecomponents. This condition maximizes the surgeon's ability to adjust thelocation of the plate after fixing the locations of the cage and nub.

In some embodiments, and now referring to FIG. 15, the nub and plate arean integral component 71 that is separate from the cage 73.

Therefore, in accordance with the present invention, there is providedan intervertebral fusion device comprising:

a) an intervertebral fusion cage having an anterior wall, a posteriorwall, leading and trailing walls connecting the anterior and posteriorwalls to form a central vertical throughhole, an upper surface adaptedfor gripping an upper endplate and a lower surface adapted for grippinga lower endplate,

b) a separate bone plate component comprising a bone contacting surface,and outer surface, upper and lower holes passing from thebone-contacting surface to the outer surface, and a projection extendingdistally from the bone contacting surface,

wherein the projection of the bone plate contacts the trailing wall ofthe cage. In some embodiments, and now referring to FIGS. 7 and 8, thenub further comprises:

-   -   iii) an upper surface adapted for gripping an upper endplate,        and    -   iv) a lower surface adapted for gripping a lower endplate

wherein each of the upper and lower surfaces of the nub is disposedbetween the first and second walls of the nub.

In preferred embodiments, gripping is accomplished by providing aplurality of teeth 75 upon each of the upper and lower surfaces. Thepurpose of these nub teeth is to enhance the snug fit of the nub betweenthe vertebral bodies and thereby further prevent the rocking of theplate.

In some embodiments, and now referring to FIG. 3, the upper surface andlower surface of the cage define a cage height, and the lower surfaceand upper surface of the nub define a nub height, and wherein the nubheight HN is not greater than the cage height Hc. This conditionenhances the ability of the surgeon to transport the nub down the sameMIS tube as the cage.

In some embodiments, the nub height is not less than the cage height.This condition enhances the snug fit of the nub between the vertebralbodies and thereby further prevent the rocking of the plate.

In some embodiments, the nub height is substantially the same as thecage height. This condition possess the attributes of the two conditionsdescribed above.

In some embodiments, and now referring to FIG. 3, the nub narrowsdistally. This contouring helps the nub locate the hole in the annulusthrough which the cage has been placed. This feature is believed to beadvantageous in MIS procedures in which the components are inserted intothe spinal area through a tube without the surgeon having a clear lineof sight.

The function of the post is to retain the plate on the nub. Typically,and now referring to FIGS. 16 and 17, the post has a threaded distal endportion adapted for threadable mating to the central hole of the nub. Insome embodiments, the post has a proximal end portion forming anenlarged head. In some embodiments thereof, the proximal head 81 has aspherical portion 83.

Typically, the post passes through the central hole of the plate andthreads into the nub. However, in some embodiments, the post can threadinto the cage as well.

Generally, and now referring to FIGS. 3 and 9, the device of the presentinvention also comprises upper and lower bone anchors 91,92 received inthe respective upper and lower holes, each bone anchor having a proximalhead 93,94 and a distal shaft 95,96. Preferably, the bone anchor is ascrew that has a threaded shaft 97,98.

Generally, and now referring to FIGS. 5 and 6, the device of the presentinvention also comprises first and second cams 101 threadably receivedin the respective threaded recesses 103 of the bone plate and bearingagainst the respective heads of the bone anchors. These cams tightenagainst the heads of the screws, thereby preventing screw backout.

The cages of the present invention may be made from any non-resorbablematerial appropriate for human surgical implantation, including but notlimited to, surgically appropriate metals, and non-metallic materials,such as carbon fiber composites, polymers and ceramics.

The interbody devices are preferably made out of PEEK or CFRP or anyother suitable material providing adequate strength and radiolucency.However, implantable metals such as titanium or stainless steelcomponents may be required to ensure adequate strength for either theinterbody device. In some cases the interbody device can be made as acombination of PEEK and metal. In some cases, resorbable materials suchas polylactide, polyglycolide, and magnesium are preferred.

In some embodiments, the cage material is selected from the groupconsisting of PEEK, ceramic and metallic. The cage material ispreferably selected from the group consisting of metal and composite(such as PEEK/carbon fiber).

If a metal is chosen as the material of construction for a component,then the metal is preferably selected from the group consisting oftitanium, titanium alloys (such as Ti-6A1-4V), chrome alloys (such asCrCo or Cr—Co—Mo) and stainless steel.

If a polymer is chosen as a material of construction for a component,then the polymer is preferably selected from the group consisting ofpolyesters, (particularly aromatic esters such as polyalkyleneterephthalates, polyamides; polyalkenes; poly(vinyl fluoride); PTFE;polyarylethyl ketone PAEK; polyphenylene and mixtures thereof.

If a ceramic is chosen as the material of construction for a component,then the ceramic is preferably selected from the group consisting ofalumina, zirconia and mixtures thereof. It is preferred to select analumina-zirconia ceramic, such as BIOLOX delta™, available from CeramTecof Plochingen, Germany.

In some embodiments, the cage member comprises PEEK. In others, it is aceramic.

In some embodiments, the first component consists essentially of ametallic material, preferably a titanium alloy or a chrome-cobalt alloy.

In some embodiments, the components are made of a stainless steel alloy,preferably BioDur® CCM Plus® Alloy available from Carpenter SpecialtyAlloys, Carpenter Technology Corporation of Wyomissing, Pa. In someembodiments, the outer surfaces of the components are coated with asintered beadcoating, preferably Porocoat™, available from DePuyOrthopaedics of Warsaw, Ind.

In some embodiments, the components are made from a composite comprisingcarbon fiber. Composites comprising carbon fiber are advantageous inthat they typically have a strength and stiffness that is superior toneat polymer materials such as a polyarylethyl ketone PAEK. In someembodiments, each component is made from a polymer composite such as aPEKK-carbon fiber composite.

Preferably, the composite comprising carbon fiber further comprises apolymer. Preferably, the polymer is a polyarylethyl ketone (PAEK). Morepreferably, the PAEK is selected from the group consisting ofpolyetherether ketone (PEEK), polyether ketone ketone (PEKK) andpolyether ketone (PEK). In preferred embodiments, the PAEK is PEEK.

In some embodiments, the carbon fiber comprises between 1 vol % and 60vol % (more preferably, between 10 vol % and 50 vol %) of the composite.In some embodiments, the polymer and carbon fibers are homogeneouslymixed. In others, the material is a laminate. In some embodiments, thecarbon fiber is present in a chopped state. Preferably, the choppedcarbon fibers have a median length of between 1 mm and 12 mm, morepreferably between 4.5 mm and 7.5 mm. In some embodiments, the carbonfiber is present as continuous strands.

In especially preferred embodiments, the composite comprises: [0119]40-99% (more preferably, 60-80 vol %) polyarylethyl ketone (PAEK), and[0120] 1-60% (more preferably, 20-40 vol %) carbon fiber, wherein thepolyarylethyl ketone (PAEK) is selected from the group consisting ofpolyetherether ketone (PEEK), polyether ketone ketone (PEKK) andpolyether ketone (PEK).

In some embodiments, the composite consists essentially of PAEK andcarbon fiber. More preferably, the composite comprises 60-80 wt % PAEKand 20-40 wt % carbon fiber. Still more preferably the compositecomprises 65-75 wt % PAEK and 25-35 wt % carbon fiber.

In some embodiments, the post and screw components of the presentinvention are made from a biocompatible metal, such as stainless steel,chromium cobalt, or titanium alloy.

In some embodiments, the plates of the present invention are made from abiocompatible metal, such as stainless steel, chromium cobalt, ortitanium alloy.

Although the present invention has been described with reference to itspreferred embodiments, those skillful in the art will recognize changesthat may be made in form and structure which do not depart from thespirit of the invention.

In some embodiments, the central throughhole of the cage is filled witha fusion material. This fusion material promotes bony fusion of theadjacent vertebral bodies through the disc space. In some embodiments,the fusion material may be autograft bone marrow or allograft bone. Insome embodiments, the fusion material may be synthetic, such astricalcium phosphate or hydroxyapatite. In some embodiments, the fusionmaterial may be a recombinant protein, such as a growth factor.

Implant Placement without a Plate Cage Connection

After successfully accessing, clearing and sizing the disc space, selectthe corresponding implant, fill the cage implant with autogenous bonegraft material and attach to the inserter. Gently impact the cageimplant into the disc space while monitoring placement under APfluoroscopy. Ideal placement of the implant is to support the endplatemedial/laterally to the contra-lateral rim and between the anteriorthird and middle third of the disc space from an anterior/posteriorperspective.

Select the appropriate nubbed plate implant based on morphology and cagesize, attach it to its respective inserter. Using the cage as a guide,insert the plate until the nubbed portion is within the disc spacesupporting the vertebral body rim and the plate portion abuts theipsilateral walls of the superior and inferior vertebral bodies. Thenubbed plate can be slightly repositioned from the cage locationanteriorly or posteriorly in order to optimize the screw location or toaccount for anomalies such as osteophytes or a slightly compromised cagetrajectory.

Attach the plate with the appropriate anchors.

Implant Placement with the Plate and Cage Connected

After successfully accessing, clearing and sizing the disc space, selectthe corresponding implant, fill the cage portion with autogenous bonegraft material and attach the plate-cage combination to the inserter.Gently impact the implant into the disc space while monitoring placementunder AP fluoroscopy. Ideal placement of the implant is for the cageportion to support the endplate medial/laterally to the contra-lateralrim and for the nubbed portion to support the ipsilateral rim while theplate portion is in contact with the walls of the superior and inferiorvertebral bodies. The implant should be between the anterior third andmiddle third of the disc space from an anterior/posterior perspective.

The nubbed plate portion can only be slightly repositioned from the cagebased on the extent of the polyaxial/sliding connection between theplate and nubbed portion. This allows for a diminished ability toaccommodate morphological or surgical anomalies but increases theergonomics of the surgery by reducing it to a single insertiontechnique.

Attach the plate with the appropriate anchors.

In some embodiments, the nub supports the ipsilateral rim of thevertebral body and the cage supports the contralateral rim of thevertebral body.

We claim:
 1. A method of implanting an intervertebral fusion device, themethod comprising the steps of: inserting an elongated member into anintervertebral space; and moving a body about a component along a curvedpath, wherein the component is interposed between the body and theelongated member and separate from both the body and the elongatedmember.
 2. An intervertebral fusion device comprising: an elongatedmember configured to be inserted into an intervertebral space; and acomponent; and a body movable about the component along a curved path,wherein the component is interposed between the body and the elongatedmember.